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CONVENTIONAL IN -GROUND POWTS DESIGN <br />WITH DOSE CHAMBER <br />Residential Application <br />Index and Title Page <br />Owner's Name: A) o r A <br />Owner's Address: <br />r <br />Site Address: r2 Y 5 5_C% /O]; <br />Legal Description: D`, y t-5- S 5/ <br />Town: L A-IFO �� f <br />County <br />Subdivision/CSM: <br />PIN: <br />Plumber Name: <br />Plumber Address: <br />Telephone <br />Signature: <br />BURNETT <br />Lot No. ` l-� Block No. — <br />�1q 5_e>5_ © elJ5- 0/5-60o <br />Page Index <br />Page 1 Index and Title <br />Page 2 Plot Plan (may include septic tank and filter specs) <br />Page 3 Distribution Cell(s) Cross Section <br />Page 4 Dose Chamber Cross Section (with ST & filter specs) <br />Page 5 Pump Curve and Specs <br />Page 6 Maintenance, Management and Contingency Plans <br />WADE RUFSHOLM <br />P.O. BOX 514, SIREN, WI 54872 <br />715-349-7286 <br />ems1 -4 <br />— <br />Date: !,� —,�?S —/9 <br />Credential No.227691 <br />